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Population Health Management May Worsen Physician Shortage

Success with population health management may actually worsen the growing physician shortage by significantly extending the lives of millions of patients.

March 22, 2017 - As the financial and professional environment for clinicians keeps getting tougher and tougher, the healthcare system is likely to continue experiencing a significant physician shortage, with up to 105,000 vacant positions expected by 2030, says the Association of American Medical Colleges (AAMC).

Surgeons are likely to be a much rarer breed by 2030, a new report predicts, with predicted shortfalls of between 20,000 and 29,000 physicians, while organizations seeking specialists are likely to post up to 61,000 unanswered job ads.

The majority of patients may be hit hardest by declining access to primary care providers, however. Projected primary care shortfalls range between 7300 and 41,300 physicians, but that number could increase if underserved populations continue to make gains in access to care.

And, counterintuitively, the shortage could become significantly more dire if the nation manages to achieve its population health management goals.

Overall, the physician shortage could total around 88,000 by 2025 and 105,000 by 2030 as the nation’s population – and physician workforce – continues to age.

While the report, prepared by IHS Markit, does note that the number of nurse practitioners, physician assistants, and other mid-level providers is making a steep upward climb, it is not completely clear how these providers will balance out the anticipated decline in physician leadership, which is currently critical for the majority of team-based care efforts and population health management programs.

Source: AAMC

Modeling physician shortages is a difficult process, says AAMC, due to a number of hard-to-quantify factors and the rapidly changing healthcare environment. For one thing, the report was developed under the assumption that the Affordable Care Act would continue to exert influence on the marketplace in its current form, which may not be the case as Congress mulls over replacement ideas.

Physician retirements are predicted to take a major toll on workforce levels. As of 2017, more than a third of physicians were between the ages of 55 and 75, and the majority of that group is likely to retire within the study timeframe.

Previous industry polls have indicated that some physicians are looking into early retirements or alternate career paths due to the growing demands of regulatory programs, the frustrations of health IT use, and rapidly rising patient volumes, which could only exacerbate the problems for their remaining colleagues.

The projections also try to balance the impact of reaching the majority of Healthy People 2020 population health management goals, which would reduce mortality rates from common chronic diseases, with the fact that longer lifespans would require more intensive physician intervention as these populations age.

Despite the expectation of temporary dip in physician demand due to the use of more PAs, NPs, and other mid-level providers to conduct care coordination and preventive care tasks, population health management could actually worsen the anticipated physician shortage.

“The main finding of this new research is that if the nation were to achieve the population health goals modeled (reduce excess body weight by 5 percent; improve control of blood pressure, cholesterol, and blood glucose levels; and stop smoking), then initially, total demand for physicians might decline due to slight improvements in average levels of health,” the report says.

“However, over time, more people would live longer, and by 2030, the demand for physicians would actually be higher than in the projections that did not model population health achievements.”

Source: AAMC

A significant reduction in chronic diseases and associated mortality could save 6.3 million adult lives, adding to an estimated US population of about 283 million in 2030.

“By 2030 national demand for physicians would be about 15,500 FTEs higher because the number of physicians needed to support these additional 6.3 million adults more than offsets the reduced demand associated with a healthier population,” the brief explains.

Many of these health gains would probably be in currently underserved areas, such as rural regions and inner cities, which exhibit much greater opportunities for large gains in outcomes than generally healthier areas of the nation.

However, a 2015 survey by Merritt Hawkins indicates that rural and underserved areas are among the least likely to attract newly graduating physicians, raising the possibility that improvements in rural health may not rise as smoothly as the AAMC models predict.

More than two-thirds of new medical residents in the Merritt Hawkins poll said they were planning to accept full-time employment at larger health systems in well-populated areas in a bid to avoid burnout, receive a secure income, and dodge the responsibility of reporting on regulatory requirements all by themselves.

Rural and underserved populations may have to depend on mid-level providers to jumpstart population health management gains, which has quickly become a key strategy for organizations concerned about completing care coordination activities without overwhelming their limited number of physicians.

The ratio of physicians to advanced practice professionals and PAs is expected to drop from 7.2 to 1 in 2015 to just 1.9 to 1 in 2030, illustrating a steep increase in the number of mid-level providers participating in team-based care.

But the AAMC notes that it is unclear if this path is sustainable or how well these providers can compensate for the higher-level insight and diagnostic skills that physicians can provide.

The conflicting forces at work appear to create something of a conundrum for the healthcare industry. On one hand, population health management programs are likely to have an extremely positive effect on patient wellness and long-term outcomes, which is encouraging.

On the other, organizations may not be able to cope with the idea of creating more demand for physicians while these professionals simultaneously flee the industry in worryingly large numbers.

To solve the problem, healthcare providers, policymakers, and health IT developers will have to work very hard over the next decade to develop new strategies that will reduce inefficiencies and maintain attractive reimbursement opportunities while making it easier for physicians to see more patients with less time on their hands.

Doing so may require providers to invest in care stratification initiatives that appropriately triage patients according to their risks, needs, and projected outcomes while leveraging emerging technology tools, like artificial intelligence, telehealth, and remote monitoring, to significantly streamline the care process and reduce burdens on the healthcare continuum.

The AAMC plans to update its physician shortage projections on an annual basis, the report concludes, in order to bring more quantitative data to the policy and strategy debates that will continue to occur across the industry.

“There continues to be a need to look more closely at individual specialties and conditions that may experience or portend future shortages,” AAMC said. “These deficits in the knowledge base present opportunities for ongoing research on the workforce implications of the evolving health care system and underscore the need for timely updates to projections.”